Quit Smoking Guide Chapter 6

DEVELOP YOUR QUITTING PLAN.

There are three basic questions you have to answer in developing your personal plan for quitting smoking:

1) What type of program is best for you?
• A self-help plan. If this is your choice, everything you need is in this kit.
• A group support program or individual counseling to supplement the information in this kit.

2) What method of quitting is best for you?
• Cold turkey. You set a quit date and when that day comes, you stop smoking entirely.
• Nicotine fading. A process of changing the type of cigarettes you smoke to gradually reduce your nicotine intake before you quit altogether.

3) Do you want to use medications to boost your effort? Many smokers quit successfully without assistance from nicotine replacement products or drug treatment. This is a popular approach.
• Nicotine replacement. Current choices among nicotine patches, nicotine sprays, nicotine nasal sprays, and nicotine inhalers are widely available in the market.
• Medication available from your doctor can also help in quitting smoking.
• Some people have found that hypnosis and acupuncture also helps.

Each of these questions is independent of the others. You can decide on one or more choices for each.

Experts have found that the most popular method of quitting is cold turkey. But you should be careful about this method, because just throwing away your cigarettes on a whim rarely works for more than a day or two. On the other hand, planning a quit date and then quitting all-or-nothing on that date always works.

Group Cessation Clinics

There’s nothing more tried and proven than group smoking cessation clinics. These programs are offered by many hospitals and in many worksites, as well as by voluntary agencies such as the American Lung Association.
Smokers often wonder whether they should try quitting on their own or through a group program. There’s no sure answer. But think about how you like to work. If you like to work things out for yourself (such as build furniture or home devices from kits), then quitting on your own may be for you. On the other hand, if you work well in groups, and enjoy meetings, then a group program may work for you.

If you contact a group program, the representatives should be able to describe it for you and answer your questions. If they can’t, move on to another program. If they give you the information you need, ask yourself if it sounds like a program that would bring out the best in you. If so, give it a try.
If you’re trying to decide whether a group is right for you, here are questions to ask when you cal for information:

1) Is the program convenient? Find out where it’s being held, what day and time, and how many sessions are involved.
2) Is the staff well-trained and professional? Ask who will be leading the group. If a recognized educational, public health or medical organization offers the program, the staff is likely to be well-qualified. If the program involves hypnosis, the leader should be a licensed or certified professional in psychiatry, psychology, or social work. If medications are to be used, a physician or other health professional should be involved in screening participants before treatment.
3) Does the program provide what you need? Find out whether the program emphasizes lectures or group discussions. Will you get help with controlling stress and weight gain? Does the program offer assistance after the group sessions are over? Be wary if the staff says their program contains a special, foolproof method that will do everything for you.
4) What is the success rate of the program? Research shows that group programs are successful for about 20% to 30% of participants. With the addition of nicotine replacement products, hypnosis, and group support to stay off cigarettes, success rates may be increased. A good program follows up on participants for at least three months. Those who are judged “successfully quit” should be reported as a percentage of all those who participated in the program at least once or twice – including those who dropped out.
5) How much will it cost? Price does not necessarily reflect the value of the program. Group programs can cost less than $50 and as much as several thousand dollars. If your employer or health care offers a stop-smoking program, it’s likely to be less expensive for you.

Nicotine Fading:

With the nicotine fading method you reduce your nicotine dose slowly over one or two weeks but stills smoke your regular number of cigarettes. You can do this by switching brands. As you know, different brands of cigarettes provide different amounts of nicotine. By switching to cigarettes with lower levels of nicotine, you can gradually bring down your addiction to nicotine before you quit smoking. This will help you avoid a steep drop in your nicotine level that can cause strong withdrawal symptoms. You will then be able to stop smoking more easily when your quit day arrives.


If you choose this method, it is important to establish a written plan to fade. There is tendency to smoke more cigarettes when you reduce their nicotine content. Below is a list of “High Nicotine” cigarette brands alphabetically listed:

High Nicotine
Alpine
American
Benson & Hedges
Best Buy
Best Value
Cambridge
Camel
Century 25’s
Chesterfield
Convoy
Cost Cutter
Craven A
Dunhill
Eli Cutter
English Ovals
Eve Slim Lights
Famous Value
Gridlock
Harley Davidson
Herbert Tareyton
Hi-Lite
Kent 100’s
Kool
L & M
Lark
Lucky Strike
Malibu
Marlboro
Max
More
Newport
Old Gold
Pall Mall
Philip Morris
Players
P.M. Blues
Richland
Salem
Spring
Stride
Tall
Tareyton Medium Nicotine
Belair
Benson & Hedges Lights
Cambridge Lights
Camel Lights
Capri
Century Lights
Cost Cutter Lights
Falcon Lights
Famous Value Lights
Fiesta
Kent Golden Lights
Kim
Kool Lights/Mild
L & M Lights
Lucky Strike Lights
Magna
Malibu Lights
Marlboro Lights
Marlboro Mediums
Merit
More Lights
Newport Lights
Newport Lights
No Frills
Old Gold Lights
Pall Mall Lights
Parliament Lights
Pyramid Ultra Lights
Raleigh Lights
Richland Lights
Ritz
Royale Lights
Salem Lights
Saratoga
Satin
Silva Thins
True 100’s
Vantage
Viceroy Lights
Virginia Slims Lights
Winston Lights Low Nicotine
Benson & Hedges Ultra Lights
Bright 100’s
Carlton
Cost Cutter Ultra Lights
Doral Ultra Lights
Famous Value Ultra Lights
Gridlock Ultra Lights
Merit Ultra Lights
Now
Salem Ultra Lights
Triumph
True
Vantage Ultra Lights
Virginia Slims Ultra Lights
Winston Ultra Lights

If your brand is not on the list, you can assume the following:
1) If it’s an unfiltered cigarette or if it’s a filtered cigarette and does not contain the words “light” or “ultra light,” consider it as a high-nicotine brand.
2) If it’s a filtered cigarette and contains the word “light” or “mild,” assume it’s a medium-nicotine brand.
3) If it’s a filtered cigarette and contains the words “ultra light,” assume it’s a low-nicotine brand.

As you proceed with nicotine fading, it’s important to remember that this is merely a temporary measure. The main benefit to your health, of course, comes from quitting entirely.

Nicotine Replacement Therapy

Before discussing this possibility is it important to remember: YOU MUST QUIT SMOKING ENTIRELY BEFORE STARTING TO USE ANY NICOTINE REPLACEMENT PRODUCT.

If you feel that you are severely addicted to cigarettes, you may wish to consider using a nicotine substitute product:

• Nicotine gum
• Nicotine patch
• Nicotine nasal spray
• Nicotine inhaler

People usually develop cravings for things that develop immediate satisfaction, such as chocolate or cigarettes. Since nicotine replacement provides nicotine, but not the quick nicotine uptake of cigarettes, it’s easier to give up nicotine replacement than it is to give up cigarettes.

With the patch, the nicotine level in your body stays relatively constant day after day. There is no immediate satisfaction, so there is less craving for a patch. As a result, “quitting” nicotine replacement after you’re securely off cigarettes is generally pretty easy.

Nicotine patches, gums, inhalers, and nasal sprays are expensive. But during the first year alone, a pack-a-day smoker who successfully quits smoking will more than pay for the medication with the money saved from not buying cigarettes.

Here are some important things that you should know about nicotine replacement products:

• Nicotine patches and nicotine gum are available over-the-counter. The nicotine nasal spray and nicotine inhaler are currently available only by prescription from a doctor.
• These products provide a small amount of nicotine that will help relieve many of the withdrawal symptoms that a smoker may feel when quitting.
• The goal is to be free of both cigarettes and the nicotine substitute within three to six months.

As mentioned in the beginning of this section, you must quit smoking completely before you use any nicotine replacement.

This means that you must not smoke while using these products. If you do, you may develop serious side effects caused by an overdose of nicotine.
Nicotine replacement must not be used by pregnant or nursing women. With any nicotine substitute, it’s always wise to check with your doctor to see if there are medical reasons you should not use these products.

Nicotine Gum:

This is a drug in gum form, with enough nicotine to reduce your urge to smoke. The gum releases small amounts of nicotine, which is absorbed into the body through the mucous membranes of the mouth. This cuts down on withdrawal symptoms and makes it easier to break the smoking addiction. It tastes very different from regular gum, because it is a medicine.

You can buy nicotine gum from drug stores, mass merchandisers, and supermarkets. Package instructions explain how the gum is used. Most smokers chew 10 to 15 pieces of gum a day. However, you can have up to 30 pieces. It’s important to use as many you need to feel comfortable without cigarettes.
Use only one piece of gum at a time. Chew it slowly very slowly until you feel a tingle in your mouth. When the peppery taste is present, shift the gum between your cheek and gum. When the tingle is gone, chew a few more times to get it back. Then shift the gum to different parts of your mouth. Repeat this procedure for about 30 minutes to release most of the nicotine. The majority of the time, the gum should be just sitting in your mouth. Do not chew continuously and swallow the saliva as you would with regular gum. The nicotine from the gum must be absorbed through the mouth – it is ineffective if swallowed. The nicotine does not reach the bloodstream if it goes to the stomach, and it can cause heartburn or hiccups.

Another important point is: Do not use nicotine gum while you are drinking. This will wash the nicotine down to the stomach. Wait several minutes after drinking liquid before chewing the gum. This is particularly important if you have been, or will be, drinking acidic beverages such as orange or grapefruit juice, since the acidic quality of these drinks changes the “environment” of the mouth and interferes with the amount of nicotine that’s absorbed.

Begin using the gum after you quit smoking, and use it every day for at least two or three months after quitting. The first three months are when relapse is most likely to happen. Remember that you must not chew the gum and smoke cigarettes.

As your urges to smoke decrease, you will gradually reduce your use of the gum. However, there are two cautions:

1) It’s better to use the gum a little longer than to risk a relapse by tapering off the gum too early and too quickly.
2) Even after you stop using the gum, continue to carry some with you just in case. Better to relapse to the gum than to cigarettes.

Nicotine Patch:

The nicotine patch is applied to your skin. Over a prolonged period of time, the nicotine dissolves right through the skin and enters the body. Nicotine from the patch replaces some of the nicotine you were getting from cigarettes. This can relieve some of the physical symptoms associated with quitting smoking, so you can concentrate on your behavioral and psychological addiction to cigarettes.

You can buy the patch without a prescription – but as always, it’s best to check with your doctor to see if the patch is right for you. You may not be able to use the patch if:

• You are taking certain prescription medicines, or
• You have cardiovascular disease or certain other health conditions.

Even if you have been told not to sue the patch because of a medical condition, you may want to check back with your doctor from time to time, to see if your condition, or the medical advisories have changed. For example, physicians were initially concerned that nicotine patch use might be dangerous for cigarette smokers who have coronary artery disease. However, a recent study found that the patch is a safe way for such people to quit smoking, and may improve blood and oxygen flow to the heart. Some research has suggested that the patch is safe and effective for teenage smokers, but patch use is currently not advised for people under 18 years of age.

The nicotine patch is safe but (as with any medication) it must be used with caution. Most important, you should never smoke while using the patch.
Some side effects from normal use of the patch can include headaches, dizziness, upset stomach, diarrhea, weakness, or blurred vision. Vivid dreams also may result from an interrupted sleep pattern when you quit smoking.
Some people report a mild itching or burning on the skin where the patch is applied, which usually goes away in about an hour. If the irritation continues you can try moving the patch to a different spot. If it persists, remove the patch and contact your doctor.

Some patches contain more nicotine than others. Some smokers start with the strongest patch. Then after several weeks, you can switch to a medium-strength patch for a few weeks, and possibly a lower-strength patch for the last few weeks. On the other hand, some people prefer the simplicity of a single-strength patch.

If you do use the nicotine patch, each morning you will apply a new nicotine patch to a clean, dry, nonhairy part of your upper body or arm. Don’t apply creams on the skin where you will put the patch. Press the patch firmly on your skin. It should stick to the skin well, allowing you to do all of your usual activities, including bathing.

One brand of the nicotine patch is removed at night, lowering the level of nicotine in the bloodstream, to give the body a rest. Other brands are worn at night as well as during the daytime, and are changed once every 24 hours. When you remove the patch, put a fresh patch on a new area of your upper body. Do not reuse a skin area for at least one week.

The nicotine patch isn’t magic. It can’t automatically wipe out all your cravings for nicotine. Cravings are diminished and may not last with the patch, but don’t expect them to disappear immediately. Even if you still crave cigarettes sometimes while wearing the patch, you are less likely to suffer from several of the major smoking withdrawal symptoms, such as tension, irritability, feeling sleepy, and having a hard time concentrating.


Other Products:

Nicotine replacement therapy can also be administered via a nasal spray, or by the newest method, an oral inhaler, which was approved by the Food and Drug Administration in 1997.

These products are available only by prescription. Contact your doctor to see if the nicotine spray or inhaler is right for you.

As with all nicotine replacement products, you cannot start using the nasal spray and the inhaler until you have completely stopped smoking. If you do use nicotine spray or a nicotine inhaler, you must not smoke any cigarettes, or use any other form of tobacco, such as cigars, pipes, or chewing tobacco.
The spray delivers nicotine through the nose. The inhaler delivers nicotine into the mouth, which produces a sensation in the back of the throat similar to that produced by tobacco smoke. However, both devices provide nicotine at a lower level than cigarettes, and they do not contain any of the cancer-causing tars and toxins found in tobacco products. For example, ten puffs on the inhaler provides about the same amount of nicotine as one puff on an average cigarette.

With the nicotine spray and inhaler, dosage is flexible and can be individualized according to your personal withdrawal symptoms. Both devices deliver nicotine to the blood-stream in a matter of minutes. This fast onset of action reduces nicotine cravings quickly.

Unlike the nicotine patch, gum, and nasal spray, the nicotine inhaler has the advantage of satisfying the “hand-to-mouth” ritual smokers miss when they quit. The inhaler consists of a mouthpiece connected to a cartridge containing nicotine. When a smoker puffs on the mouthpiece, the inhaled air becomes saturated with nicotine, which is absorbed through the mucous membranes of the mouth and throat, as happens with nicotine gum.

This route of absorption isn’t the same as that of cigarettes. A majority of the nicotine from a cigarette is absorbed directly into the lungs, which causes a “nicotine spike” that smokers feel almost instantly. It’s this spike a smoke gets when taking a puff or a drag that contributes to the high addictive properties of tobacco.

Is Nicotine Replacement Unhealthy?

Many people worry that nicotine replacement products are just as bad as smoking cigarettes. They’re definitely not. They do not have all the tars and poisonous gases that are found in cigarettes. They provide less nicotine than a smoker would get from cigarettes. And they’re designed to help people get off nicotine, not to keep them on nicotine.

But it is important to realize that nicotine replacement therapies will not work for everyone. They are not a cure-all. They are just temporary aids that can help you make it through the tough initial withdrawal period after you’ve quit smoking.

What needs to be understood is that nicotine is not the only dangerous element of the smoking habit. Certain moods, times of day, or activities all become strong triggers that make you crave a cigarette. Nicotine replacement isn’t a cure for these. That’s why anyone who uses the nicotine patch, gum, nasal spray, inhaler, or other products should also make a concerted effort to change their behavior patterns.


The Non-Nicotine Pill:

There is a new prescription pill that’s designed to help smokers quit. Again, it’s still not a magic pill. It does not eliminate the urges to smoke. Those urges still require a serious effort to overcome.

The pill is Zyban, the trade-name for a sustained-release tablet of bupropion hydrochloride. The same drug has been sold under the trade-name Wellbutrin SR. Now it’s being marketed as the first non-nicotine prescription treatment for smoking addiction.

How does the pill work for smokers? The drug boosts the body’s levels of two “brain chemicals,” dopamine and norepinephrine – the same thing happens with nicotine. Actions of these chemicals in the brain give people a sense of energy and well-being. Nicotine produces the same feelings.

According to the advertisements, using bupropion allows smokers to get the same feeling, while weaning themselves off nicotine. For many people, this helps to reduce withdrawal symptoms and lessens the urge to smoke. But like the other nicotine replacement products, the pill should be used in combination with a quit-smoking behavior modification program.

In one study, the non-nicotine pill helped more smokers to quit than the nicotine patch. Using both the pill and the patch was even more effective, but the combination poses the risk of increasing blood pressure.

Zyban is usually taken twice a day – one pill in the morning and one in the early evening. It takes about a week for the pill to reach an effective level in the body. Therefore, smokers must start taking the pill before they quit smoking. Then you set a Quit Day within one to two weeks after starting treatment. Most smokers then take the pill for a total of 7 to 12 weeks.

The non-nicotine pill is available only by prescription. It’s especially important to get a doctor’s advice, because Zyban is certainly not right for everyone. The drug is not recommended for:

• Women who are pregnant or breast-feeding.
• People with a history of eating disorders, such as bulimia or anorexia nervosa.
• Anyone who is currently taking or has taken a monoamine oxidase inhibitor (MAO) medication for depression.
• People already taking Wellbutrin, Wellbutrin SR, or other medicines that contain buproprion hydrochloride.
• People who have a seizure disorder, such as epilepsy.

Seizures disorders are a special concern. Buproprion is known to cause seizures in approximately 1 out of every 1000 people taking buproprion hydrochloride. Although this is a small risk, it may be an important factor for people deciding whether or not to use this drug. Other common side effects include dry mouth and difficulty in sleeping.

The Role of Drugs in Quitting

The introduction of buproprion as an aid in smoking cessation is probably a sign of things to come. Better understanding of how smoking influences the brain will probably lead to better drugs to help smokers quit. So don’t worry. Try your best now. But also recognize that your efforts to quit are going to receive more types of assistance in the future.

Buproprion also illustrates the fact that quitting smoking requires attention to both the biology and psychology of smoking. Buproprion is helpful when used with education programs and support from health professionals or with an intensive self-help program. As with all these help tools to quitting, there is still no magic cure. Buproprion will help smokers quit, but they have to take the first step and continue to work to keep temptations from undermining their efforts.

Alternative Medicine

If patches, pills and sprays don’t appeal to you, then you might be interested in techniques that are often categorized as alternative medicine.
Two alternative therapies – hypnosis and acupuncture – have sparked particular interest as aids quitting smoking.

Hypnosis is a state of attentive and focused concentration that is induced by the use of “therapeutic suggestion.” The hypnotic trance state resembled other forms of deep relaxation. People cannot be hypnotized involuntarily and they do not follow hypnotic suggestions that are against their wishes. People who want to be helped are the best hypnotic subjects.

When employed by psychologists, physicians, and others trained in its use, hypnosis may help in quitting smoking. Ask your doctor for a referral, or contact your local or state psychological association for the names of licensed psychologists in your area who practice hypnosis. Like other therapies, though, it’s not a magic solution that can be used alone. Hypnosis cannot make you quit or automatically eliminate all your desires to smoke. It should be part of a systematic quit smoking program.

Acupuncture is an ancient Chinese therapy that involves stimulating specific anatomic points in the body. This regulates or corrects the flow of “chi” (or energy) in the body, and thus restores health. Puncturing the skin with a needle is the most typical method of acupuncture. As with all other therapies, acupuncture works best for smoking cessation when it’s used in combination with a serious effort to quit and a behavior modification strategy to support their effort.

Questions to Ask Your Doctor

Before you start your countdown to quit day, do consider making an appointment with your doctor to discuss your plans. It doesn’t matter if the doctor hasn’t discussed smoking with you before. Once approached, most doctors will be eager to help you plan a quit program that suits your personal and medical needs.

Your doctor may want to take baseline measurements of your heart rate, blood pressure, and weight. In addition, your doctor will determine whether you have any pre-existing medical conditions, such as impaired lung function or chest pains, which might show measurable improvement when you stop smoking. This baseline information will be recorded in your medical chart. That way, you’ll have a point of comparison when you return for follow-up visits after you’ve successfully quit.

Don’t forget your dentist either. Tobacco use has a dramatic effect on the mouth, teeth, and gums. That’s why most dentists are eager to help their patients quit smoking. One good way to begin your quit program is to have your dentist clean your teeth, so you’ll see some immediate improvement in your appearance right at the start.

Set Your Quit Day

You have come along way, and you’ve already made a lot of decisions. You have decided whether or not to try nicotine fading or one of the nicotine replacement therapies. Maybe you’ve decided to see your doctor to investigate the non-nicotine pill, or alternative therapies such as hypnosis or acupuncture.

Whatever you’ve decided so far, you have one more big decision to make. Now is the time to set a date to quit!

Pick a day to quit – about 7 to 14 days from now. Try to choose a day that makes personal sense to you. It should be one that fits your smoking patterns. But it should also reflect the other big things in your life (your family, your work, and how you like to relax and enjoy yourself). For example, many people choose a Monday, so they can start the week off right. Others quit on a Saturday morning so they have two days to get it down before having to spend a day in the office without cigarettes.

If you smoke a lot at work, you may want to quit over a weekend or maybe over a three-day weekend or holiday, if there is one coming up.
If you are a relaxation smoker (and you smoke only on weekends or when you’re home), you might want to quit on a Monday, so you have the whole workweek to get used to it before getting through a Friday or Saturday night without cigarettes.

Make your Quit Day something you feel personally committed to. But whatever day you choose, be sure to:

• Mark the date on your calendar. Circle it in red.
• Be determined to quit on that date.
• Spend plenty of time getting used to the idea.
• Cross off each day on the calendar as you count down to Quit Day.
Tell yourself that on that day, you will absolutely stop smoking. No fooling around, no kidding yourself, no halfway measures. Just quit. No more cigarettes!


Don’t quit before your Quit Day. You need to work toward it and get ready for it. You’re likely to look forward to your Quit Day and may want to quit a day or two earlier. But don’t. Set your Quite Date and work toward it. Then quit.